Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Hypernatremia is frequent in the intensive care unit (ICU) and is associated with adverse outcomes. Despite its prevalence, robust evidence to guide treatment is lacking, and global practice patterns are largely unknown. We investigated global treatment preferences and clinicians' willingness to enroll patients in a randomized trial to inform its feasibility. METHODS: This international cross-sectional online survey comprised 20 primarily closed-ended questions, using five-point Likert-scale responses, across four themes: treatment method, threshold, correction rate, and opinion on a proposed trial. Respondents considered a clinical vignette of hypernatremia developing before or during ICU admission, excluding dehydration and chronic causes. It was distributed to ICU physicians worldwide. RESULTS: The survey was sent to 3053 ICU physicians in 17 countries, with 1051 respondents, yielding a response rate of 34%. Of respondents, 74% were consultants, and 26% were residents. The mean ICU experience was 14 years. Increasing free water intake via enteral route was the most frequently reported treatment strategy (80% reporting "often" or "always"). Moderate hypernatremia (plasma sodium 151-156 mmol/L) was the most frequently reported threshold for initiating correction (533/892, 60%). 45% (396/888) preferred a correction rate of 8-12 mmol/L/day, and 41% (366/888) of < 8 mmol/L/day, with the remainder having no correction rate target or correction rate target of > 12 mmol/L/day. 74% (654/882) reported no barriers to enrolling eligible patients in the proposed trial. CONCLUSION: Among ICU physicians, correction of hypernatremia is mostly achieved by increasing free water intake using hypotonic fluids, predominantly via the enteral route. Most clinicians initiate treatment once hypernatremia reaches a moderate level, aiming for a correction rate of < 12 mmol/L/day. Most clinicians expressed willingness to enroll eligible patients in the proposed trial. EDITORIAL COMMENT: This survey study aimed to sample physician preferences for treatment of hypernatremia when on their way to or in the ICU. This study sampled respondents in many countries, and based on different phases of treatment and assessment, as well as participant willingness for a future treatment trial.
DOI: 10.1111/aas.70386
Authors: Hans Eric Sebastian Seitz‐Rasmussen, Morten H. Bestle, Olav Lilleholt Schjørring, Andrew Ratcliffe, Aoife O'Grady, Jonathan Silversides, Marcus Broman, Peter Bentzer, Pedro Povoa, Johanna Hästbacka, Kristian Strand, Paul Young, Niels Van Regenmortel, Carmen A. Pfortmüller, Manu L. N. G. Malbrain, Ahmad Nasser, Martin Sigurdson, Meint Volbeda, Sine Wichmann, SALT‐ICU Survey
Institutions: Copenhagen University Hospital, University of Copenhagen, Aalborg University Hospital, Aalborg University, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Belfast Health and Social Care Trust, Queen's University Belfast, Lund University, Skåne University Hospital, University of Lisbon, Odense University Hospital, Hospital of St. Francis Xavier, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Tampere University, Pirkanmaa Hospital District, Tampere University Hospital, Stavanger University Hospital, University of Bergen, The University of Melbourne, Wellington Hospital, Medical Research Institute of New Zealand, Monash University, Ziekenhuis aan de Stroom, University of Bern, University Hospital of Bern, Medical University of Lublin, The University of Queensland, Queen Elizabeth II Jubilee Hospital, University of Iceland, National University Hospital of Iceland, University Medical Center Groningen, University of Groningen
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,430
Funders: Gentofte Hospital, Nordsjællands Hospital
OpenAlex ID: W7225305737